Is It Age or Muscle Strain? Why Peripheral Arterial Disease Often Goes Undiagnosed

Peripheral arterial disease (PAD) affects an estimated 230 million people worldwide, yet many individuals remain undiagnosed. This is not due to rarity or absence of symptoms, but rather because presenting complaints are frequently attributed to more common, non-vascular conditions.

What is Peripheral Artery Disease (PAD)?

Peripheral arterial disease (PAD) is a condition in which the arteries that supply blood to the limbs, most commonly the legs, become narrowed or blocked.

This occurs due to atherosclerosis, a process in which fatty deposits (plaque) build up within the arterial walls, reducing blood flow.

As a result, the muscles and tissues of the legs may not receive enough oxygen, particularly during physical activity. This can lead to symptoms such as leg pain while walking, known as intermittent claudication.

PAD is a common vascular condition and is often associated with broader cardiovascular health, including an increased risk of heart disease and stroke.

Is it ageing, or something more?

Leg pain while walking, a feeling of heaviness in the calves, or a gradual reduction in walking distance are often considered part of normal ageing. As a result, these symptoms may not lead to further evaluation.

In PAD, however, these changes occur due to:

• Narrowing of arteries supplying the legs
• Reduced blood flow during activity
• Limited oxygen delivery to muscles

PAD is common and treatable, but it may not always be recognised early.

What do people often assume about these symptoms?

Many individuals explain their symptoms as:

• Muscle fatigue
• Reduced activity levels
• Joint-related problems such as arthritis

These are understandable assumptions, particularly in older adults. However, they may not fully explain the underlying cause.

A key symptom of PAD, intermittent claudication, typically presents as:

• Pain or discomfort in the legs during walking
• Occurring at a predictable level of activity
• Improving with rest

Recognising this pattern is important in identifying the condition.

How can PAD be distinguished from other causes of leg pain?

PAD can resemble more common conditions, but certain features may help differentiate it.

In PAD:

• Pain is linked to walking and improves with rest
• Symptoms are consistent and predictable

In other conditions:

• Joint pain may occur at rest or with specific movements
• Nerve-related pain may improve with changes in posture

Additional signs that may suggest reduced circulation include:

• Cold feet or temperature differences between legs
• Changes in skin colour or texture
• Slow-healing wounds

Why can diagnosis be delayed?

Leg pain is a common concern, and symptoms are often initially attributed to non-vascular causes. Without specific vascular assessment, PAD may not be identified at an early stage.

This reflects how the condition presents, rather than its importance. PAD shares symptoms with several more common conditions like osteoarthritis, physical deconditioning or weight-related joint stress, which can make it less immediately apparent.

What happens if PAD is not recognised early?

PAD is a progressive condition. Over time:

• Arterial narrowing may increase
• Symptoms may become more frequent or severe
• Walking distance may reduce further

In more advanced stages, patients may develop:

• Pain at rest
• Non-healing wounds
• More serious circulation problems

PAD is also a marker of systemic atherosclerosis and other underlying vascular health issues, associated with a higher risk of heart disease and stroke.

Why does PAD remain underdiagnosed?

Contributing factors include:

• Symptom overlap with common conditions
• Variable clinical presentation
• Atypical or absent symptoms in certain populations (e.g., diabetes)
• Absence of routine screening programmes

As a result, diagnosis is often dependent on symptom recognition and appropriate referral.

When should you consider getting checked?

A vascular assessment may be helpful if:

• Leg pain occurs regularly with walking
• Symptoms improve with rest
• Symptoms do not improve with usual treatments
• Risk factors such as diabetes, smoking, or high blood pressure are present

How is PAD evaluated?

Initial evaluation is simple and non-invasive.

Ankle-Brachial Index (ABI):

• Compares blood pressure in the ankle and arm
• Helps identify reduced blood flow
• Can be performed quickly in an outpatient setting

Further tests may be recommended if needed.

What difference does early diagnosis make?

Early diagnosis allows for timely management, including:

• Medications to improve vascular health
• Lifestyle and risk factor management
• Structured exercise programmes

Where indicated, endovascular treatment may be performed to restore blood flow:

• Balloon angioplasty and/or stenting
• Image-guided, minimally invasive approach
• Reduced recovery time compared to open surgery

Delayed diagnosis may limit the feasibility of such interventions.

In selected cases, minimally invasive procedures may be used to improve blood flow. These approaches are most effective when the condition is identified early.

Why RIVEA

RIVEA offers dedicated evaluation and management of vascular conditions, including PAD, with a focus on early diagnosis and minimally invasive care.

• Specialist-led vascular assessment
• Advanced, non-invasive diagnostic techniques
• Expertise in image-guided, endovascular treatments
• Individualised care based on patient needs

Early assessment can help guide appropriate treatment and improve long-term outcomes.